Coronary artery disease among asymptomatic diabetic and non-diabetic patients undergoing coronary CT angiography
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Coronary artery disease among asymptomatic diabetic and non-diabetic patients undergoing coronary CT angiography

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Zeina AR, Blinder J, Rosenschein U, Zaid G , Barmeir E

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  • 1. CORONARY ARTERY DISEASE AMONG ASYMPTOMATIC DIABETIC AND NONDIABETIC PATIENTS UNDERGOING CORONARY CT ANGIOGRAPHY Zeina AR, Blinder J, Rosenschein U, Zaid G , Barmeir E _______________________________________________________________________________ Zeina et al, Coronary Artery Disease 2008, 19:37–41
  • 2.
    • Coronary artery disease (CAD) is the major cause of death among patients
    • with diabetes. However, the true prevalence of CAD in asymptomatic
    • diabetic patients remains unknown
    _______________________________________________________________________________
    • Diabetic patients, particularly those with other risk factors, are
    • usually treated aggressively without differentiation based on the presence
    • or absence of identifiable CAD
    Zeina et al, Coronary Artery Disease 2008, 19:37–41 Introduction
  • 3.
    • Only a few non-invasive studies using stress SPECT imaging in
    • asymptomatic diabetics have been reported. By providing no information
    • regarding coronary artery wall and lumen, this technique can reveal only
    • positive test results and not the true prevalence of anatomic CAD
    _______________________________________________________________________________ Zeina et al, Coronary Artery Disease 2008, 19:37–41 Introduction
  • 4. The aim of this study was to determine the prevalence and severity of CAD and the plaque composition in asymptomatic diabetic patients undergoing coronary CT angiography (CCTA) _______________________________________________________________________________ Purpose Zeina et al, Coronary Artery Disease 2008, 19:37–41
  • 5.
    • - The study population consisted of 328 consecutive patients (254 men,
    • mean age 56 ± 8 years) who presented to the outpatient clinic and were
    • referred for further evaluation of suspected CAD: 42 diabetics and 286
    • non-diabetics
    • All participants were asymptomatic for cardiac-related symptoms before
    • the examination
    • Each participant had at least one risk factor for CAD (diabetes mellitus,
    • hypertension, hyperlipidemia, smoking history, or family history of
    • symptomatic CAD) or abnormal stress-test results
    Materials and Methods _______________________________________________________________________________ Zeina et al, Coronary Artery Disease 2008, 19:37–41
  • 6. Table 1. Baseline characteristics of diabetic and non-diabetic patients. _______________________________________________________________________________ Zeina et al, Coronary Artery Disease 2008, 19:37–41 0.96 101 (35) 15 (36) Smoking, n (%) 0.34 152 (53) 19 (45) Hyperlipidemia, n (%) 0.17 138 (48) 25 (59) Hypertension, n (%) 0.19 126 (44) 14 (33) Family history, n (%) 0.17 213 (74) 38 (90) Male gender, n (%) 0.10 56 ± 9 58 ± 8 Age (years ± SD) (N= 286) (N= 42) P value Non-diabetic patients Diabetic patients
  • 7.
    • CAD was defined as coronary atherosclerosis, with obstructive or non-
    • obstructive lesions
    • CCTA was performed using two different MDCT scanners, the Lightspeed
    • 16 Pro and VCT (General Electric Medical Systems, Milwaukee, WI)
    • Findings were compared between patients with diabetes and those without
    _______________________________________________________________________________ Materials and Methods Zeina et al, Coronary Artery Disease 2008, 19:37–41
  • 8.
    • The total Agatston score was significantly higher in diabetics versus non-
    • diabetics (370 ± 96 and 79.9 ± 16, respectively; P < 0.0001)
    • CAD was present in 39 ( 93% ) diabetics and in 211 ( 73 % ) non-diabetics
    • ( P = 0.006)
    • Obstructive CAD was more common in diabetics than in non-diabetics (29%
    • vs. 6.6% respectively; P < 0.0001)
    • In diabetics, more coronary segments with atherosclerosis per patient were
    • detected (5.5 segments/patient vs. 2.8 segments/patient in non-diabetics;
    • P < 0.0001)
    _______________________________________________________________________________ Results Zeina et al, Coronary Artery Disease 2008, 19:37–41
  • 9. Table 2. CCTA characteristics of the study population and comparison between diabetic and non-diabetic patients. * P value < 0.05 is considered significant. CCTA= coronary CT angiography _______________________________________________________________________________ Results Zeina et al, Coronary Artery Disease 2008, 19:37–41 0.1 1 (0.3%) 1 (2%) Three-vessel disease 0.3 2 (0.7%) 1 (2%) Two-vessel disease < 0.0001 16 (5.6%) 10 (24%) One-vessel disease < 0.0001 2.8 5.5 Segments with plaques/patient 0.07 141 (49%) 27 (64%) Non-obstructive CAD < 0.0001 19 (6.6%) 12 (29%) Obstructive CAD 0.006 211 (74%) 39 (93%) Coronary plaques < 0.0001 79.9 ± 16 370 ± 96 Total Agatston score (n= 286) (n= 42) P value * Non-diabetic patients Diabetic patients
  • 10. 54-year-old asymptomatic diabetic patient MIP 3D-VR CCTA Zeina et al, Coronary Artery Disease 2008, 19:37–41
  • 11. Discussion
    • Using the same diagnostic modality, such high prevalence
    • of CAD in asymptomatic diabetics has also been recently
    • reported ( Scholte et al, Heart 2007)
    • Our findings are in keeping with those of autopsy studies
    • identifying a high prevalence of coronary atherosclerosis in
    • patients with diabetes, even among those without clinical
    • CAD ( Goraya et al , J Am Coll Cardiol 2002)
    _______________________________________________________________________________ Zeina et al, Coronary Artery Disease 2008, 19:37–41
  • 12.
    • Our results indicate a high prevalence (93%) of CAD in
    • asymptomatic diabetics with either non-obstructive or
    • obstructive lesions
    _______________________________________________________________________________ Conclusion
    • CCTA may be a useful imaging modality for selecting patients at
    • high risk who would benefit most from further evaluation for
    • subclinical ischemia
    Zeina et al, Coronary Artery Disease 2008, 19:37–41